Provider Demographics
NPI:1477540896
Name:TAYLOR, JOHN KARL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KARL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4062 FLYING C RD
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-9664
Mailing Address - Country:US
Mailing Address - Phone:530-676-8234
Mailing Address - Fax:530-676-0819
Practice Address - Street 1:4062 FLYING C RD
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-9664
Practice Address - Country:US
Practice Address - Phone:530-676-8234
Practice Address - Fax:530-676-0819
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2023-03-07
Deactivation Date:2016-03-21
Deactivation Code:
Reactivation Date:2016-04-08
Provider Licenses
StateLicense IDTaxonomies
CAG036151207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G0361510Medicaid
CA00G0361510Medicaid
CA00G0361510Medicaid
CAE36151Medicare UPIN
CA00G0361510Medicare ID - Type Unspecified